do you need an msa

The General “Requirements” of an LMSA: A Technical Review Medicare Set-Asides (“MSA”) cannot exist without Medicare’s right to reimbursement first being stated in the law. Those rights arise from the Medicare Secondary Payer Statute, 42 U.S.C. § 1395y(b)(2) (“MSP”) and 42 C.F.R. 411 et. seq. Then we must note that, MSP regulations and Centers for…

Read More
medicare to pay for acupuncture

CMS announced a coverage determination that will allow Medicare to pay for acupuncture that treats chronic low back pain. This new coverage is highly consequential in the legal industry as the stated purpose is to expand options that reduce opioid use. Opioids just so happen to be a major expense in Medicare Set-Asides (MSAs). Health…

Read More

Trostle v. Medicare: Part II Previously, we wrote about and analyzed Trostle v. Centers for Medicare and Medicaid Services. Following dismissal for lack of jurisdiction, this Medicare lien litigation continued with a counter-suit by the United States government. Part II of our case study will explore errors made that caused the government to react with…

Read More

CMS’s newest time frame to create a Liability Medicare Set Aside (“LMSA”) process has come and gone. Again. We’ve seen CMS make multiple attempts to create a process and then pull them back. CMS’s Liability Medicare Set-Aside History In 2012, CMS issued an Advanced Notice of Proposed Rulemaking (“ANPR”) requesting comment on potential rules; CMS…

Read More

Medicare’s new Workers’ Compensation Review Contractor (“WCRC”) is set to take over all Medicare Set-Aside (“MSA”) reviews on Monday, March 19, 2018. The new contractor, Capitol Bridge, LLC, has stated it expects no changes to the process or timeframes for review. It has provided new contact information though: WCRC New Phone:                         833-295-3773 WCRC New Email:                          WCRC@CapitolBridgeLLC.com…

Read More

Please remember Medicare liens for what it considers No-Fault and Workers’ Compensation files may not change for a few days. Performant Recovery, Inc. officially takes over tomorrow, February 8, 2018; however, CGI is handing off all data beginning today, February 7, 2018. All CRC files will re-start processing (mail, faxes, etc.) on Monday, February 12, 2018.…

Read More

As we’ve previously discussed, Medicare’s CRC contractor is changing from CGI to Performant Recovery, Inc. on February 8, 2018. The CRC is having three days of what it is calling it’s, “Dark Days” from February 7 thru 9, 2018. What does this mean? Medicare No-Fault and Workers’ Compensation files will be accessible, but, no additional…

Read More

CMS can finally move forward with its new Medicare Set-Aside (“MSA”) contractor. While that contract was awarded in September, two organizations challenged that award arguing that CMS “unreasonably failed to permit offerors to make oral presentations and failed to conduct discussions.” More interesting, Arch Systems, LLC argued that the agency “failed to reasonably evaluate the…

Read More

Ahmad Zeki, Director of Business Development at Massive, will be presenting to the Inland Counties Association of Paralegals on Wednesday, January 17, 2018. The topic is ‘Lien Resolution and Future Medicals: The Ever-changing World of Liens & Future Medicals and How to Deal with Them.’ Dealing with lien claims management is frustrating and tedious. Each lien requires…

Read More

Medicare (CMS, BCRC, CRC, or any other contractor) does not speak for Medicare Advantage Plans (“MA Plans”). MA Plans do not speak for Medicare. These two statements could not be more important as MA Plan providers like Humana become more aggressive in suing to enforce their Medicare Part C liens. Last week, an attorney asked…

Read More